Orthorexia: the eating disorder you won’t find in the DSM
Orthorexia:
the serious eating disorder you won’t find in the DSM
Your alarm goes off at 6am- the sun has not yet risen, but you find yourself up and throwing on the work out clothes you meticulously laid out the night before. You lace up your gym shoes and you’re off to complete a high intensity workout followed by a protein shake, an apple, and exactly six almonds. You’re exhausted, but this is your routine that you stick to- no pain, no gain. To the outside observer, it looks like you are passionate about a “healthy” start to the day, but what they can’t see is the anxiety, self doubt, and paralyzing fear driving these behaviors.
At work, your co-workers want to go to lunch at their favorite local spot at 11am, but you panic because you typically eat lunch at 12pm and you quickly go to the restaurant’s website to look at the menu to see if they offer any “healthy” choices or list the calorie counts or ingredients so you can make sure they offer “clean” meals. If not, you make up an excuse to bail and eat lunch at your desk alone instead. A few hours later, you also decline to join them for happy hour because you don’t need to “drink your calories” (whether you have an alcoholic drink or a “mocktail”) and your coworkers admire your “discipline” and how “good” you are being.
At home, you keep yourself busy until exactly 5pm when you plan to eat dinner- but face decision fatigue over what to eat. Do you make the food you’re craving, or what you think you “should” eat for a “healthy, balanced meal”? You end up making pasta, but avoid cream-based sauces or oil, and also make a huge salad to “fill up on veggies”. You still feel hungry, but you instead eat more salad or chug water and brush your teeth to try to control your body’s natural signals because you have already had the amount of calories that your diet says “should” be enough. Never mind that you found this diet on the instagram page of an influencer, as opposed to a registered dietitian.
You try to distract yourself with TV after dinner… but the leftover pasta in the fridge is calling to you. You try to resist and end up eating the leftovers standing in front of the fridge straight from the tupperware. You feel like a failure and start eating every snack in your pantry. Guilt surges and you throw the rest of the snacks in the garbage and resolve to restrict even more, work out even harder tomorrow. You vow to skip all work lunches for the rest of the month because you need to “control” yourself and only eat ingredients you deem “clean” or “pure”.
Many of the above behaviors are normalized or even celebrated and praised in our diet and weight obsessed culture. Someone who says no to social events, only eats “organic” foods, and who prioritizes extreme workouts, is often called disciplined or “healthy”, but may be struggling with an eating disorder known as Orthorexia.
Orthorexia is an eating disorder that is characterized by an obsession with eating only "healthy" or "pure" foods. Individuals with orthorexia may become hyper-fixated on the quality and purity of their food, to the point where it becomes a significant source of anxiety. Rigidity around food, diet, and exercise becomes disordered when it causes a level of stress that gets in the way of day-to-day life (i.e. an unhealthy obsession with “health” and “wellness”).
Some common signs and symptoms of orthorexia may include:
Spending an excessive amount of time researching and planning meals
Developing rigid rules and dietary restrictions about what to eat and when
Avoiding all foods that are deemed "unhealthy" or “impure" with little to no exceptions
Feeling guilty or ashamed after eating foods that are not considered "clean" or "pure"
Becoming socially isolated due to dietary restrictions
Experiencing anxiety or distress when faced with situations where "clean" food is not available or when forced to deviate from a particular diet or plan
Having a distorted body image or fear of weight gain despite being underweight or a normal weight
Developing nutritional deficiencies due to restrictive eating patterns
Individuals struggling with Orthorexia may find themselves in conflict with their values- prioritizing a meal plan over time with friends and loved ones or choosing a work out over rest or hobbies that previously brought them joy. Following a strict diet or focusing on the purity of food may help them temporarily avoid anxiety, but fuels disordered habits that keep them trapped and increases anxiety over time. Instead of feeling more confident or self assured, individuals struggling with eating disorders struggle with self worth because it becomes depending on their bodies- which are meant to grow and change over time. Instead of becoming more confident and self assured, individuals struggling with Orthorexia often feel increasingly trapped and anxious.
It's important to note that orthorexia is not an official diagnosis in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), but it is recognized by many healthcare professionals as a type of disordered eating that can lead to significant physical and emotional health consequences. If you (or a loved one) are struggling with your relationship with food and body image, it might be time to connect with a therapist trained in eating disorders. Eating disorder therapy can help you to develop a healthier relationship with food and your body, and to address any underlying patterns of thinking that may be contributing to your disordered eating behaviors.
Emily Lombardo Counseling provides outpatient therapy for eating disorders for individuals in Missouri who are ready for freedom from diet culture and want to establish or regain trust in their body. Click the contact link to set up a free consultation and see if working together feels like a good fit (or for resources and referrals for other amazing folks in the St. Louis area).